A Doctor’s Tale of Two States

(published as an editorial in the Manhattan, KS Mercury on 10/30/13)

Maggie Kozel
Contributing Writer

Hello, Kansas! I am a pediatrician from Rhode Island and am very proud to tell you that my daughter attends your fabulous veterinary school. (Go Wildcats!) She has been having wonderful experiences at K-State, but now, because she lives in Kansas, she is about to join the ranks of the uninsured.

Most of us here in Little Rhody are big fans of the Affordable Care Act, and we understand most of you are not. Yet we share a history. Since the 1990s, both our states have been nurturing a federally-funded program to expand Medicaid health coverage. Its called SCHIP.

Similar to the ACA’s current Medicaid expansion initiative, this plan uses federal money to enroll children whose parents earn up to 250 percent of the federal poverty level into private insurance plans. If you haven’t heard of the SCHIP program that Kansas offers, it’s worth looking up. Since enacting common-sense coverage for children in Rhode Island, all kinds of health measures, including immunization rates, have improved, and preventable hospital admissions and ER visits have steadily declined. I saw my practice dramatically change overnight when SCHIP was enacted. Instead of treating the “haves” and scrambling to do the best I could for the “havenots,” I was able to care for 95 percent of my patients to the very highest standards. What a privilege!

Our experience with SCHIP over the past two decades factors into our eagerness to accept federal money for expansion this time around. For one thing, the individual mandate suits our hearty New England souls: If you can afford health insurance, why would you expect the rest of us to cover your butt when you slip in the shower? But we also know that there are folks who fall into an income gap — earning too much to qualify for public assistance but not enough to purchase private insurance. We want them to be able to afford coverage too, and now, with the ACA’s combination of marketplace competition, tax credits and subsidies, most of the 80,000 uninsured people in Rhode Island will have the opportunity to do just that.

Before you write us off as a bunch of bleeding heart liberals, let me point out that we are equally as guilty of yankee frugality. We stage protests over 10-cent bridge tolls and hold endless town meetings to argue the cost of a highway barn. But as SCHIP demonstrates, what’s good for the patient can be good for the taxpayer. We like that.

Obviously, the people of Kansas made different choices, and turned down the Affordable Care Act’s federal money that would have funded 100 percent of expansion for the next three years, then dropping to 90 percent. You have such serious misgivings about it that you decided that one in six people in your state will have to remain uninsured.

We all know that doesn’t mean they won’t need health care. Mothers will put off mammograms and fathers will not get their blood pressure treated. If they develop appendi-citis or skid into a truck on the highway, they will quickly run up huge medical bills they can’t pay, and the taxpayers of Kansas will pick up the tab.

Our daughter, who earns a whopping $8,000 a year by working two part-time jobs, is too rich for subsidized insurance in a state like Kansas that rejects Medicaid expansion. However, she may still qualify as a Rhode Island resident and thus be able to obtain affordable comprehensive insurance. She would have to schedule all doctor appointments during her visits home. If she needs prescriptions, we will send them to her. If she gets sick, we will help her decide if it can wait until she gets back. We’ll make it work, even as we shake our heads in dismay. At least she has this imperfect option; 350,000 of your neighbors in Kansas will not.

My guess is that we all want similar things from our health-care system: high quality, cost effectiveness, affordability, compassion — a system that puts our precious healthcare dollars to work in a way that makes the best use of our medical resources.

These are the standards that any reform effort should be measured against. We all need to keep these essential goals, not political rhetoric, front and center in any health care debate.

A year or so from now we’ll need to look back, take an honest account of what has worked and what hasn’t — hmmm… websites maybe? — and learn from each other.

Maggie Kozel practices pediatrics in a community health center in Rhode Island. She is the author of “The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine,” and a member of the nonpartisan Doctors for America, which advocates for quality, affordable healthcare for all.

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